Background
Prospective single-arm institutional study. 30 patients with symptomatic early-stage Peyronie's disease (induratio penis plastica, IPP) with penile plaque confirmed on ultrasound and painful erections and/or erection curvature ≤60°. Treated with RT to penile plaque. Evaluated outcomes of RT on plaque reduction, pain resolution, and sexual function. Niewald M et al, Strahlentherapie und Onkologie.
Interventions and follow up
Arm A: RT: 36 Gy in 18 fractions (2 Gy/fraction), 5 days/week, to penile plaque; orthovoltage or electron beams; lead shield to teste
Primary endpoint: Pain response, plaque stability, functional outcome
mFollow up: 24 month
Primary endpoint: Pain response, plaque stability, functional outcome
mFollow up: 24 month
Results
Pain relief at 6 months: 87% (complete or partial pain response)
Plaque stabilization: 73% (no increase in plaque size on ultrasound)
Curvature improvement: 27% (partial correction); 60% stable; 13% progression
Erectile function: Maintained in 80% of baseline-potent patients
Plaque stabilization: 73% (no increase in plaque size on ultrasound)
Curvature improvement: 27% (partial correction); 60% stable; 13% progression
Erectile function: Maintained in 80% of baseline-potent patients
Adverse events
Main adverse events: Acute: penile skin erythema grade 1–2 in 60%, dry desquamation 15%, no grade ≥3. Late: no significant fibrosis, no RT-induced ED, no urethral stricture at 24 months. Testicular dose: <0.5 Gy with shielding — no measurable hormonal effects.
Conclusions
RT at 36 Gy for Peyronie's disease effectively relieves penile pain and stabilizes plaque size in the majority of patients with tolerable acute toxicity. RT does not improve curvature significantly but prevents further progression. RT is appropriate for the acute inflammatory phase with painful erections.
Key Limitations
Key Limitations: Small sample size (30 patients), single-arm. No randomized comparison to observation or medical therapy (colchicine, vitamin E, phosphodiesterase inhibitors). Peyronie's disease has high spontaneous pain resolution rate — contribution of RT vs natural history is uncertain. Curvature correction requires surgery (plication, grafting) in most cases regardless of RT.
Clinical Context
RT is an option for Peyronie's disease in the acute phase with painful erections, primarily for pain management and plaque stabilization — not for curvature correction. Current evidence supports RT as a conservative option before surgical correction is considered. NCCN and EAU guidelines include RT as an option for early-stage Peyronie's with pain.
References